To compare the effect of limbal dissection combined with ICL implantation and toric ICL implantation on astigmatism correction in patients with high myopia

Abstract

Background To compare the safety, efficacy, predictability and stability of implantable collamer lens (ICL) implantation with limbal relaxing incision (LRI) and toric ICL (TICL) implantation for correcting corneal astigmatism in high myopic patients. Methods This prospective clinical study recruited high myopic patients with a preoperative cylinder ranging from − 1.5 D to -1.0 D. Patients were randomly divided into two groups: 35 eyes of 25 patients underwent independent TICL implantation (TICL group), and 35 eyes of 20 patients underwent ICL implantation combined with LRI (LRI group). Uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were observed before and at the end of the 1st and 3rd months postoperatively. The outcomes considered were refraction and corneal topography preoperatively and 3 months postoperatively. The variation in astigmatism was analyzed using vector analysis, which included surgically induced astigmatism (SIA), target-induced astigmatism (TIA), and the correction index (CI). Safety, efficacy, predictability and stability were also analyzed. Results LogMAR UDVA and logMAR CDVA were significantly improved 1 and 3 months postoperatively in both groups (P < 0.001). LogMAR CDVA in the LRI group was significantly higher than that in the TICL group at 1 month postoperatively (P = 0.001); logMAR UDVA was significantly higher than that in the TICL group at 3 months postoperatively (P = 0.025). AST in the LRI group was significantly reduced postoperatively (P = 0.001); there was no significant difference in the TICL group (P > 0.05). There was no statistically significant change in SIA or TIA between the two groups (P > 0.05) 3 months postoperatively. The CI of the two groups indicated mild overcorrection, without a statistically significant difference between the groups (P > 0.05). No complications occurred during the 3-month follow-up. The short-term safety of the LRI group was significantly higher than that of the TICL group (1.18 ± 0.23 vs. 1.01 ± 0.39, P = 0.029). Conclusions LRI combined with ICL implantation is effective for correcting low to moderate astigmatism in the short term. The safety, correction effect of astigmatism and visual acuity are better than that of TICL implantation. LRI is feasible as an astigmatism correction method for patients with high myopia and corneal astigmatism. Trial registration None.